title: Predictors of mortality in patients undergoing autologous hematopoietic cell transplantation admitted to the intensive care unit.
abstract: Between January 2001 and July 2006, 1013 patients received autologous hematopoietic cell transplants (AHCT) at Canada's largest transplant center. In this retrospective cohort study of AHCT patients admitted to the intensive care unit (ICU), we describe the outcomes following ICU admission and the variables measured in the first 24 h of ICU admission associated with overall ICU mortality. Results indicate a 3.3% ICU admission rate (n=34) with 13 deaths (1% overall mortality rate, 38% in ICU mortality rate). The worst outcome was in AL amyloid patients of whom 28% were admitted to the ICU, with an ICU mortality rate of 55%. The Sequential Organ Failure Assessment (SOFA) score and Acute Physiology and Chronic Health Evaluation (APACHE II) score in the first 24 h were statistically associated with mortality by univariate analysis. Other variables measured at 24 h and associated with ICU mortality included multiorgan failure, mechanical ventilation, inotropic support >4 h and Gram-negative sepsis. Our data indicate that ICU admission in the autotransplant population is rare and that it is influenced by underlying diagnosis, with AL amyloid patients having the highest risk. Our observations may assist clinical decision-making regarding the continuation of intensive care delivered 24 h after ICU admission.
authors.affiliation: University of Toronto Autologous Blood and Marrow Transplant Program, Princess Margaret Hospital, Toronto, Canada. martina.trinkaus@utoronto.ca
authors.forename: M A
authors.initials: MA
authors.lastname: Trinkaus
authors.forename: S E
authors.initials: SE
authors.lastname: Lapinsky
authors.forename: M
authors.initials: M
authors.lastname: Crump
authors.forename: A
authors.initials: A
authors.lastname: Keating
authors.forename: D E
authors.initials: DE
authors.lastname: Reece
authors.forename: C
authors.initials: C
authors.lastname: Chen
authors.forename: D C
authors.initials: DC
authors.lastname: Hallett
authors.forename: N
authors.initials: N
authors.lastname: Franke
authors.forename: A
authors.initials: A
authors.lastname: Winter
authors.forename: J R
authors.initials: JR
authors.lastname: Mikhael
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000401:mortality; D012121:Respiration, Artificial / Q000401:mortality; D012189:Retrospective Studies; D014182:Transplantation, Autologous